• Symptoms
• considered to be one of three "disruptive behavior" disorders, along with Conduct Disorder and Oppositional Defiant Disorder
• symptoms present in childhood and in more than one setting
• characterized by a variety of symptoms which comprise two groups:
• Differentiation of Hyperactive vs. Inattentive Types:
• Hyperactivity/Impulse
• fidgets
• often leaves seat
• runs about
• difficult being quiet
• blurts out words
• difficulty waiting
• often on the go
• Inattentive
• fails to give close attention to detail
• difficulty sustaining attention
• does not follow through
• easily distracted
• difficulty organizing
• Etiology
• family history Þ biological (genetic)
• neuroimaging Þ hypometabolism (no tests available for diagnosis)
• Epidemiology
• disruptive behavior is the #1 reason a child is brought to a pediatrician offic
• just because a child displays disruptive behavior does not mean that he/she has a Disruptive disorder
• 5% of children suffer from ADHD, 3 times as many boys than girls
• ADHD persists through adolescence and into adulthood; original belief that ADHD "remits" during adolescence is probably due to the fact that the symptoms change across the life cycle Þ an adult is more sedentary than a child
• scientific evidence that many children with ADHD are not diagnosed despite the public perception of its over diagnosis
• if they are not diagnosed they are not treated
• serious disorder that may lead to significant difficulties that persists into adulthood such as Ý rates of antisocial and substance abuse and possibly mood disorders during adulthood
• Diagnosis of ADHD
• It is a Clinical Diagnosis
• based on careful physician interview; no specific tests available
• must cause an impairment or dysfunction; chronic disorder
• Differential Diagnosis/Assessment
• symptoms of ADHD may be present in a variety of medical or psychiatric conditions (lead toxicity, mood disorders, psychotic disorders, substance abuse, and other disruptive behavior disorders, non-syndromal disorders)
• Clinical Evaluation
• family history (runs in families)
• longitudinal history
• Co-Morbidity Associated with ADHD
• 50-80% of patients with ADHD have a co-morbid disorder
• disruptive behavioral disorders (30-50% of patients), Mood or Anxiety disorder, Substance Abuse, Learning disorder, PDD
• Impact of ADHD
• serious disorder that may lead to significant difficulties that persists into adulthood
• impact on education, emotion, social interactions, family and peers (pts often become the class clown or daredevil)
• increased rates of antisocial and substance abuse and possibly mood disorders during adulthood

Treatment - multimodal treatment plan

• Pharmacotherapy: most beneficial
• Stimulants Þ stimulate underactive areas of the brain
• Pros: long term efficacy, no long-term side effects
• Cons: 30% failure rate
• Side effects: anorexia, weight loss, stomach pain, insomnia, tics (induces tics only in susceptible people)
• does not stunt growth and abuse is not common
• Examples:
• Methylphenidate (Ritalin) - most common drug (short acting)
• Pemoline (Cylert) - severe hepatotoxicity
• O-Amphetamine
• Adderall (longer acting and more potent than Ritalin)
• Medication Monitoring: CBD, lead level, BP and pulse
• Antidepressants
• tricyclics
• MAO inhibitors Þ Ý Dopamine, serotonin
• Buproprion Þ very effective but can cause irritability and insomnia
• Fluoxetine ( blocks benzodiazepam receptor) - only reported as successful once but still in use (Certraline and Paroxetin are other similar drugs)
• Venlafaxine
• a₂ Agonists
• Clonidine and Guanfacine
• Antipsychotics: not recommended, considered only treatment of last resort
• Psychosocial - school based, family, peer, individuality
• Psychotherapy - can lead to significant improvements especially in the mildly effected
• school intervention, individual treatment, rehabilitation model, multisegmental perspective